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References on Heroin, Morphine, and the Opiates | ||||
Frequently Asked Questions about Heroin, Morphine, and the Opiates |
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Frequently Asked Questions About the OpioidsEditor: Mike Hamilton <mdh@debug.cuc.ab.ca> Last Update: 10 Jan. 94 Editors Note: If anyone has any info that they would like to share with me and possibly have included in this FAQ, please send all mail to my mailbox at mdh@debug.cuc.ab.ca
ContentsOpioid Info: Natural (known as opiates): Semi-Synthetic (known as opioids): Heroin Hydrocodone (Hycodan) Synthetic (also known as opioids): Opioid Addiction and Withdrawal The FAQ will use morphine as the standard opioid and base all other opioids in relation to it. Glossary:opiate - narcotic analgesic derived from a natural source(opium poppy) opioid - narcotic analgesic that is either semi or fully synthetic - also refers to entire family of both opiates and opioids IM - intramuscular injection SC - subcutaneous injection MorphineSynopsisMorphine is naturally occurring substance in the opium poppy, Papaver somniferum. It is a potent narcotic analgesic, and its primary clinical use is in the management of moderately severe and severe pain. After heroin, morphine has the greatest dependence liability of the narcotic analgesics in common use. Morphine is administered by several routes (injected, smoked, sniffed, or swallowed); but when injected particularly intravenously, morphine can produce intense euphoria and a general state of well-being and relaxation. Regular use can result in the rapid development of tolerance to these effects. Profound physical and psychological dependence can also rapidly develop, and withdrawal sickness upon abrupt cessation of heroin use; many of the symptoms resemble those produced by a case of moderately severe flu. Morphine is infrequently encountered in the North American street drug culture. However, mainly because of its availability in hospitals, there have been several documented cases of morphine dependence among health professionals. Drug SourceMorphine is isolated from crude opium, which is a resinous prep of the opium poppy, Papaver somniferum. Trade NameRoxinal, MS Contin, Morphine Sulfate Street Names"M", morph, Miss Emma Drug CombinationsUse of morphine plus cocaine, as well as of morphine plus methamphetamine, has been reported. However, such combinations are not frequently encountered. Medical Uses* symptomatic relief of moderately severe to severe pain; * relief of certain types of difficult or labored breathing; * suppression of severe cough (rarely); * suppression of severe diarrhea (e.g., that produced by cholera). Physical AppearanceMorphine is legally available only in the form of its water-soluble salts. Most common are morphine sulfate and morphine hydrochloride. Both are fine white crystalline powders, bitter to the taste. Both are soluble in water and slightly soluble in alcohol. Dosage~~~~~~ MedicalFor moderate to severe pain the optimal intramuscular dosage is considered to be 10 mg per 70 kg body weight every four hours. The typical dose range is from 5 to 20 mg every four hours, depending on the severity of the pain. The oral dose range is between 8 and 20 mg; but with oral administration morphine has substantially less analgesic potency (approximately one-tenth of the effect produced by subcutaneous injection) because it is rapidly destroyed as it passes through the liver immediately after absorption. The intravenous route is employed primarily for severe post-operative pain or in an emergency; in this case the dose range is between 4 and 10 mg, and the analgesic effect ensues almost immediately. NonmedicalIrregular or intermittent users (who are not substituting the drug for another narcotic analgesic) may start and continue to use doses within the therapeutic range (e.i., up to 20 mg). However, regular users who employ morphine for its subjectively pleasurable effects frequently increase the dose as tolerance develops. To take several hundred milligrams per day is common, and there are reliable reports of up to four or five grams (4000 - 5000 mg) per day. Routes Of AdministrationMorphine may be taken orally in tablet form, and can also injected subcutaneously, intramuscularly, or intravenously; the last is the route preferred by those who are dependent on morphine. Short Term Use~~~~~~~~~~~~~~ Low Doses (single doses of 5 - 10 mg administered by S.C or IM injection in non-tolerant users) CNS, behavioral, subjective: suppression the sensation of and emotional response to pain; euphoria; drowsiness, lethargy, relaxation; difficulty in concentrating; decreased physical activity in some users and increased physical activity in others; mild anxiety or fear; pupillary constriction, blurred vision, impaired night vision, suppression of cough reflex. Respiratory: slightly reduced respiratory rate. Gastrointestinal: nausea and vomiting; constipation; loss of appetite; decreased gastric motility. Other:slight drop in body temperature; sweating; reduced libido; prickly or tingling sensation on the skin (particularly after intravenous injection). Duration4 - 5 hours Dependency Potentialhigh, continued use results in both psychological and physical dependency CodeineDrug SourceCodeine is found in opium in concentrations between %0.1 and %2. Because of the small concentration found in nature, most codeine found in medical products is synthesized from morphine via the methylation of the hydroxyl group found on the second non-aromatic ring. Trade NameThere are no commercial name for products containing only codeine in US. Found under common name of codeine. Canada does have a codeine only syrup available under Paveral. Mainly found in combination products. Street NameT-three's (Tylenol #3 w/ codeine), schoolboy, cough syrup Medical Uses* relief of mild to moderate pain * relief of non-productive cough * relief of diarrhea Drug CombinationsSold under many name brand products, the most popular being theTylenol with Codeine series, the number on the tablet corresponds to the amount of codeine and caffeine found in the each tablet. Tylenol #1 w/ codeine - 8 mg codeine, 15 mg caffeine Tylenol #2 w/ codeine - 15 mg codeine, 15 mg caffeine Tylenol #3 w/ codeine - 30 mg codeine, 30 mg caffeine Tylenol #4 w/ codeine - 60 mg codeine, no caffeine note: all tablets contain same amount of acetaminophen (300 mg) Fiorinal (aspirin, caffeine, barbital, codeine) Many other brand name product combinations. Physical AppearanceTylenol w/ codeine series are imprinted with number on one side and other side is Tylenol label(McNeil). Controlled Substance StatusAs a single product codeine is a schedule II controlled substance in the US. When combined with other non-controlled substance, and depending on amount per dose unit, codeine combined products range from schedule III to V. Canada has OTC codeine products available if product has no more than 8 mg of codeine per unit dose. Some US areas may have codeine preps available OTC, but usually require release form. As an interesting fact, a travelers handbook noted that Greece has banned codeine in that country (no idea on what it's status is now) so be careful when traveling there. Dosage~~~~~~ MedicalPain relief : 30mg - 220mg oral or equivalent dose SC or IM Diarrhea relief : 10mg - 20mg orally Cough suppressant : 5mg - 15mg orally NonmedicalDoses can range from 30mg up to 400mg. LD50 for codeine is 800mg in a average nontolerant person. At doses of > 250mg adverse effects tend to arise, including intense itching, flushed skin, dizziness, sedation, nausea and vomiting Routes Of AdministrationUsually taken orally but can be injected IM or SC. The IV route is not recommended as reactions such as facial swelling, pulmonary edema and convulsions can occur. Short Term Use~~~~~~~~~~~~~~ CNS, Behavioral, Subjective:Effects begin at 30mg and tend to mimic those of morphine, except sedation and euphoria are less intense. Respiratory:same as morphine but less intense. Gastrointestinal:same as morphine but nausea and vomiting are less common and constipation less severe. Other:alleocodone is a schedule II drug, and when combined with other non-controlled drugs, is found from schedule III-IV. Dosage~~~~~~ Medicalas a cough suppressant 5mg - 10mg for pain relief 10mg - 30mg Nonmedicaldoses are similar to those for pain relief Routes Of AdministrationUsually taken orally but can be inject via three routes. Unknown if hydrocodone can be sniffed or smoked. Sniffing is likely possible. Short Term Use~~~~~~~~~~~~~~ CNS, Behavioral, Subjective: Has similar effects as morphine but less sedation and euphoria Respiratory: Less depression than morphine. Gastrointestinal: Less likely to cause nausea and vomiting than morphine. Other:Hydrocodone is a weaker opioid than morphine but still a effective opioid with similar potency to oxycodone. Duration3 - 4 hours Dependency Potentialmoderately low, much less potential than morphine HydromorphoneDrug SourceSynthetically produced from morphine. Trade NameDilaudid Street NameDillies Medical Uses* relief of moderate to severe pain * relief of severe cough Drug Combinationsmost commonly used as a single product Physical Appearanceusually bought as tablets, or injectable solution Controlled Substance StatusHydromorphone, like most single product opioids, is a schedule II opioid. Dosage~~~~~~ Medicalfor pain relief 1mg - 2mg Nonmedicalsame as pain relief doses Routes Of AdministrationCan be administered orally, by three routes of injection, and by sniffing. Unknown if smoking is an effective route. Short Term Use~~~~~~~~~~~~~~ CNS, Behavioral, Subjective: Hydrocodone has effects similar to morphine, except euphoria is similar to codeine, nausea and vomiting is quite rare, and sedation is practically non-existent Respiratory: Hydrocodone depresses respiration minimally. Gastrointestinal: Hydromorphone effects GI tract very little. Other:Although hydromorphone's euphoria pales with other opioids it's abuse potential comes from the fact the rush experienced from IV use is very similar to heroin's. Hydromorphone is one of the most used opioids in the relief of pain for the terminally ill. The reasons being it's minimal side effects, and high potency. Duration3 - 4 hours Dependency Potentialmoderately high MeperidineDrug SourceMeperidine is completely synthetic and can be produced with dichlorodiethyl methylamine and benzyl cyanide. Trade NameDemerol Street NameDemmies Medical Uses* originally found to be useful for muscle spasms but the discovery of it's analgesic properties has resulted in it's almost exclusive use for relief of moderate to severe pain Drug Combinationsusually found as a single product, with few combination products. Is found in combination with acetaminophen in Demerol APAP Physical AppearanceDemerol tablets are small white tablets with the name Winthrop on one side Controlled Substance StatusSchedule II substance in US Dosage~~~~~~ Medicalpain relief is achieved with approx. 50mg - 150mg injected or 200mg - 300mg oral Nonmedicaldoses similar to those used in medical settings are used in recreational use. Routes Of Administrationorally, three injection routes, and sniffing are possible, unknown if smoking is possible Short Term Use~~~~~~~~~~~~~~ CNS, Behavioral, Subjective:same as morphine but less sedation, less intense euphoria Respiratory:respiratory depression tends to be less common and less intense than morphine Gastrointestinal:nausea and vomiting are reportedly common with oral use, but less when administered via injection Duration3 - 4 hours Dependency Potentialreported to be less than or equal to that of morphine OxycodoneDrug Sourcesynthesized from codeine Trade Nameonly found as a compound product combined with aspirin or acetaminophen. Available in Canada as a single product in the form of a suppository Street NamePercs Medical Uses* relief of moderate to severe pain Drug CombinationsPercodan is aspirin and oxycodone Percocet is acetaminophen and oxycodone Physical AppearancePercodan tablets are color coded according to quantity of oxycodone in each tablet, the pink have ~2.5mg and the orange and green having twice as much Controlled Substance StatusSchedule II in US Dosage~~~~~~ Medical10 - 20mg oral for pain relief 5 - 15mg injection NonmedicalDoses similar to those used in a medical setting are used Routes Of AdministrationCan be administered orally, three injection routes, sniffed and possibly smoked. Short Term Use~~~~~~~~~~~~~~ CNS, Behavioral, Subjective:Same as morphine but milder. Respiratory:Less respiratory depression than morphine Gastrointestinal:Less constipating than morphine Duration3 - 4 hours Dependency PotentialModerate FentanylDrug SourceSynthetically produced Trade NameSublimaze Street NameChina white Medical UsesMainly relief of moderate to severe pain and as a surgical anesthetic Drug Combinationsnone Physical AppearanceFound as a injectable solution, and a transdermal patch Controlled Substance StatusSchedule II in US Dosage~~~~~~ Medical50ug - 200ug Nonmedicalsame range as medical use Routes Of Administrationcan be administered via three injection routes, sniffed and smoked Short Term Use~~~~~~~~~~~~~~ CNS, Behavioral, Subjective:euphoria is less than morphine Respiratory:same as morphine but has potential to cause respiratory muscles to go into spasm and result in respiratory arrest Gastrointestinal:less constipating that morphine Duration1 - 2 hours Dependency Potentialmoderately high MethadoneDrug Sourcesynthetically produced Trade NameDolophine Street NameDollies Medical Usesoccasionally used for pain relief, but main use is in opioid withdrawal treatment as a substitute drug Drug Combinationsnone Physical Appearancefound as a fruity solution for oral use, in wafers, and tablets also found as a injectable solution Controlled Substance StatusSchedule II in US Dosage~~~~~~ Medical3 - 5mg provides same pain relief as 10mg morphine Nonmedicalrarely used non-medically, but doses used are approx. same as medical doses Routes Of Administrationcan be injected via three routes, taken orally, unknown if methadone can be smoked, can be sniffed Short Term Use~~~~~~~~~~~~~~ CNS, Behavioral, Subjective:Oral use provides little euphoria and tends to block opioid receptors in brain, so commonly used as a maintenance drug during rehab. Respiratory:Produces little depression in contrast to morphine Gastrointestinal:produces constipation of less intensity than morphine Other:Developed by Nazi Germany during WWII as Germany was unable to acquire adequate supplies of morphine. Durationfirst dose last approx. 8 hours and subsequent doses last 18 - 24 hours. Dependency Potentialoral use provides little euphoria so little abuse potential in that form. When injected, methadone give very similar effects to morphine so has similar addiction potential. PropoxypheneDrug SourceSynthetically produced with similar structure to that of methadone Trade NameDarvon, Darvon N Street Namenone Medical Usesfor relief of mild pain Drug CombinationsDarvon compound is aspirin and propoxyphene Physical AppearanceDarvon N as pink oval pills Controlled Substance StatusSchedule III in US Dosage~~~~~~ Medicalrange from 50mg - 150mg of hydrochloride Nonmedicalsimilar to medical dose ranges. Routes Of Administrationcan be taken orally, three possible injection routes, no info on possible intranasal or smoked administration Short Term Use~~~~~~~~~~~~~~ CNS, Behavioral, Subjective:oral use provides very little euphoria, mild sedation; at larger doses sedation becomes quite prominent and symptoms such as staggering and slurred speech become apparent. Respiratory:little respiratory depression in medical dose range Gastrointestinal:little effect on GI tract Other:IV use is reported to give rush similar to heroin; poor analgesic with standard dose providing less pain relief than standard aspirin dose Duration3 - 4 hours Dependency Potentiallow PentazocineDrug Sourcesynthetically produced Trade NameTalwin Street Nameyellow footballs Medical Usesfor relief of moderate to moderately severe pain Drug CombinationsTalwin NX - pentazocine and nalaxone (opioid antagonist) Physical Appearanceusually found in orange-yellow tablets Controlled Substance StatusSchedule III Dosage~~~~~~ Medical50mg - 100mg for pain relief Nonmedicalsimilar to medical dosage Routes Of Administrationcan be taken orally, three injection routes, and sniffed possibly smoked Short Term Use~~~~~~~~~~~~~~ CNS, Behavioral, Subjective:poor opioid, very little euphoria, mainly just sedates and clouds mind, little recreational use Respiratory:less depression than morphine Gastrointestinal:very little constipation or nausea, vomiting occurs Other:as a opioid agonist/antagonist has potential to cause psychotic effects such as hallucinations, severe confusion Duration3 - 4 hours Dependency Potentialmoderate potential, similar to hydrocodone Opioid Dependence And WithdrawalOpioids have specific withdrawal and dependence characteristics common to all opioids, varying according to the specific drug. All opioids cause both physical and psychological dependence with prolonged use. Depending on the opioid in question withdrawal can become evident after continued use in as little time as 2 weeks or as long as 2 months. Withdrawal is commonly overstated by media and tends to be similar to bad case of flu. This is due to the fact that most opioid users don't tend to be able to acquire enough drug to result in severe withdrawal. It must be noted that physical symptoms may be similar to flu, psychological symptoms can be quite painful. Depression, mood swings, hypersensitivity to pain are some common symptoms. Opioid withdrawal DOES NOT endanger life as does alcohol and other depressant withdrawal. |
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